HomeMy WebLinkAboutMCMAHON #2 BLK 8 LT 3
MUNICIPALITY OF ANCHORAGE__.
hh and Environmental Pro'N 'ion
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
264-4720
INSPECTION REPOR¥ ON-SITE ,fi ~:,:¥¢AOt:'' ':" DISPOSAL
~,~. c '~-',~ ~
NAME. _~ ......... MAILING ADDRE~*S .~/~ ..... ¢...~_..k.2 ..................... PHONE
SEPTIC TANK,:
O,ST/~NCE
FROM
INSIDE WIDTH LIQUID DEPTH ......... UQUID CAPACITY/~]~¢~_ GALLONS.
INSIDE LENGTH
TILE DRAIN FIELD:
/ _,,~/~, ~ j TOTAL LENGTN
DISYANCE FROM WELL/~ FOUNDATION__~ ...... NEAREST LOT LINE..~Q .......... OF'LINE
~ of Lines .... / ...... DISTANCE BETWEEN LINES __.~/~ ..... TRENCI~ WlD'H~ IN. TOTAL EFFECTIVE
DEPHI
OF
FILTER
I
DEP'IlI: )0° OI 7 ILE 1'O FINISII GRADE
, MATERIAL BENEATlt TILE____~___ ...... I~ABOVE TILE .... LIN,
SEEPAGE PIT:
DIAMETER OR
Log Crib Rings
BUILDP~G FOUNDA~, ION ___
Crib Size: O AMETE~,~ ._(_)EP'FI{ ......... DISTANCE F'ROM: WELL
TO1 AL L-F'FECTIVE
NEAREST LOT LINE _ _. . ABSORPTION AREA (WAL.L AREA)
.__SQ. FT,
lass: Depth:
/ell Distance To: Lot Line
~ldg: Sewer Line:
· of Bedrooms:
f. etllar k s:
F:iF'Ft. i C:~ f',iT
L "] E: Fl':i' T 0 N
[ E-J 3F!_
L. OT S::i;
'i'S.'F'E '" t::' '=;i-i 'r~ F:IE~S;OF::EKf' ): "N S"r'"Z':;I"EH i E;: T,~:ENC:H
MF:i;4]:HLii'i NLff"iE:EF? :F iFEE:,F.:TK:HS = 4
':_=;OIL RRTZNG '::SQ F'T,."E:i'R>== :1.5(i~
THE.'; LEN(.:iTE-i D:I:i"IENS:;:[::"¢'~ irE; THE L. ENCYFH ,']:N FEET::' OF ]"Hi.]!] 'TF::Ei'.,K]:H O['~: t)F~:FtiNFiEL, i':,.
THE i]:,EF"/"I4 OF: Fi TF:F=:NE:H OR F'i"t' 'fS TME [:,I:i.'-.i'T'l:::li'.4(]:E: E~iE'TI4EEN THE ':'~!JE'FFiL-:E OF THE
Gt:;tOL i'.~i:::, ~:::,i'..![:' THE: En3'f'TOM :' F: '¥'~-q:S E;:-O]F:I',,,'FIT ! Fd'-,i ,' i N F=EET'::,.
Ti.-tiEi~:F:; .T.:i:'; NO SET NIDTH FOF-: ~.'PEN'L'.-~E'.::,-.q.
?'H!E "Ji;'~::t',.';!:'i. [:,EF'TFI ILS ]"HIS M.[HiM.iM E:,EF'TH OF OP.'.=I','b;l..., E:E:]"14EEF4 ]'HE-: CIIjT'FRi._L F'iF'E~:
FIN[:, 'THii'E [~:O"I'TOM OF THE ~:.,..,L.H,,H ILl',t "IN F'EET'::'.
Fi i::'F!E:!:::R(:':i'E PL. FINT' i"!FP¢ Erie tNS'.;TFtL. L_E[:' FIT THi.E F'Ei:Ri'"iiTTEiE"':S 7t::'-'i'Cd",! S;IjB.J'EX.'.:T TO THE:
:.L. .,L..]):THE:~: F! C:!_I::IS:~ I Ol~i ii N'.SF FIF'F'I;]tO',,,'EC, F'LFINT MFI'.¢ EJ[::.:
Fi COi'.~T ]1 i'.,iL.it;IUS f"ll::l ]' NTENFti~.,iE:E RGfqEEMENT i '.S F4:E[.:!I..i ]: i:;.'.Et:::,. I F FI. HFI '.'
FIGF;:Ei::i]'"iij:~NT i :::3 'NO]" i::]Ei='T :;':i.IF4:Fi:Ei'.4"I" '-/:l!j f'iR'¢ E:E ~:[E!;!U ~ ~;~:[ii;[:, TO .EN_I:~P Z'~E 'FHt::_Z '.SI:; T. L.
E-iEv.:i;ORPTiON L':;"r'::::';"'F£"'i FINC,,-"'OF~: "?OU I"'iFI"¢ E:E ';SUE:,TECT ]"O F'RZ'SEf':LtT!ON
E¢I:iC:i':::F: J:i.J_ I N(ii OF i:::it",i"¢ S"r'STEH !-,J.. i 'Tiq(Z I.j-[ F: i NFtL I N'.E F'F- '" T iZ Z i"l Fft'qD FIF'F:'F;:OVF:IL EFt' "['H Z
OEF:'FI.P::TMEi'~T' i.,.I]:L.L. E',E :=:;I. jEL]'EC]" TCi
M:i:i"4Zi"ii.Ji'"I [)i'i:;T'F!?',!C:E-':: iiiIETI.,.iEEN Fl I.,.IFJ:LJ.. FIND Rf',l"r' OI',!'-'.SZTE LE, EI4R(:IiE Di".=_';F:'O:~;RI.... 'S"r'.STEM
i. OO F'Ii:ZET F'Oi;;;: FI PF;::I:VFtTE: I,K:':L.L. OR 200 FEET FOR A I::'UE~LT.C NELL.
kiEl. X~ LOG% FIRE REE-:IU:I:!~tEC' FIND i"ii. jS'f' BE.'.' tR!E-FURNEC' TO THE [:,EF"E-IF.'YFhiEN'i" t.4ITHi'N :~:Ci
OF i-FiE 14EL. L COMF:'L. ETION.
O]"HE.!;;~: I::~:FZ(;!Li i Ri.:i:Mi'EN'TS h'iFl? Ri::'F'i...."r'. %PEE: 1' F 1' E:Wf' :i: ONS AN[::' C':Oi'4%'T'I~tLtE:T I Oi"4 C, .1.' FiGRRH'.E; ARE
FtVF:I ! L.F:iFi&.E TO ! NS;UP;:E PROP[.:'.'I:;~: Z N:STRLLF':H"Z ON.
.T. E:ER'i"i F'¢ THFt'I"
:i..: :il At'-'1 FI:=tMiLiFIF.: kiii'H THE RIE[.:!LiiRE:ME:NTS FOR ON-S;iIE SEi4ERS; FINE:, !dEl_L::_; R'.S :BET'
FORTFi L=..:'¢ THE FiUN I' C I PF:tL :i: T'-¢ OF RNCHOF.':FIGE.
:;::: i 14 :i: LJ.... ZNS'i'FtLL THE S'¢STEM ]:hi FICCORDFINCE !.4ZT'H THE: CO[>EtiS.
ii:: :[ UNDERS;TFi,N[::, "i'HFIT' THE ON-5:[i"E :~EP.iEF.': i:;'-,-'%TEH MR"¢ REQU:I.'RE !ENL. RF,'GEMEN'T'
i:RE:S):C,'~ENCE 1% i"-';:EMOi]:,E:LED 'FO T i'-,!E:L. LtC, E i¥IOF.'tE ]"HRN d. E~EDF4:OOMS.
RPPL.iCFINT ~~ E:ONST
I F T !'"iE
l)ej}artment of tlealth ;md Environment~ Protection
2516 E. Tudm' Road ,
AllC}IOI'a[}'O, Alns]<a 99507
276-2221
)unLc!'cd? ~0,
SiX INCH WATEr WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE rATE OF
PROPERTY OWNER ~'
LOCATION OF WELL SITE
DRILLER /~ ~ 0,~ ,~
~19. O0 PER FOOT.
~ tte~zSo¢ 279-4865 2415
~f~t. 3 BLIc. 8 ~c f/~
WELL LOG:
o ..... :~ ,: g~u~ ~.ta 3oo~ c,~ ~out~.
151..-184'
184--186'
.~e.c. 18.~A, 1977
Be2m~;a C_Am~
~-"MUNICIPALITY OF ANCHORAGE'~=~
DEPARTMEN, OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage. Alaska 99501
264-4'720
Date Received: April 18, 1978
#1: Time 1:30 p.m. #2: Time #3: Time
Date 4-19-~8 Wed Date Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Alaska Statebank
Mailing Address: 310 East Northern Lights Blvd. Phone:
2. Property Owner: Ed Herzog
Phone:
Mailing Address: 2418 East 20th Avenue
279-7637
277-3166
3. Legal Description: Lot 3 Block 8 Mc Mahon Subdivision
4: Single Family Residence: (x)
Multiple Family Residence: ( )
Number of Bedrooms: Four
Number of Bedrooms:
Well System:
Permit #
Construction
Individual Well (x) Community/Public System ( )
Depth of Well 186' Well Log on File (x)
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System (x) Public Utility ( )
Installed Installer
/~'~) Manufacturer ~
Soils Rate J_~D Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Department of Health'and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description: Lot 3 Block 8 Mc Mahon Subdivision
Comments:
Affadavit Attache~
APpr°ved: ['~
Disapproved
Letter Attached: )
Date:
Date:
Department Worksheet:
MUNICIPALITY OF ANCHORAGE
Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 99501 ·
uest for Approval of Individual Sewer and Water Facilities
Property Owner:
Mailing Address:
2' Name of Buyer:
e
Mailing Address:
Lending Institution:
Mailing Address: ~'-~./ '
Realtor/Agent:
Mailing Address:
Legal Description:
Street Location:
Phone:
Phone:
Single Family Residence: (~ Number of Bedrooms:
Multiple Family Residence:
( ) Number of Bedrooms:
If Individual Well, well depth ,//2f'~
If Community System, name of system
8. Sewage Disposal System: *~n-site System
If On-site System, date of installation:
Water Supply:.. *Individual Well (~ Public/Community System ( )
( ) Public System ( )
~NOTE: A well log is required on ALL wells drilled since 6/75.
** If on-site sewer system is over two(2) years old, an adequacy
test is required by this department.
A fee of $25.00 must accompany each request before processing
can be initiated.
3/77
Drinking Water Analysis Report for Total Coliform Bacteria
TO BE COMPLETED BYWATERSUPPLIER
PUBLIC WATER SYSTEM:
I.D. NO.
Public Water System Name ~ i
Mailing Address
Zip Code
City State
Mo. Day Year
SAMPLE TYPE:
[] Routine
[] Check Sample (for routine sample
with lab ref. no. _)
[] Special Purpose
SAMPLE
NO.
t
2
5
LOCATION
[] Treated Water
[],Untreated Water
Time i Collected
Collected By
TO BE COMPLETED BY LABORATORY
LABORATORY:
NAME
ADDRESS
CITY
Date Received
Time Received
Analytical Method:
Eli Fermentation Tube
[] Membrane Filter
Lab Ref. No. Result* Analyst
I J III
* NO. of colonies 1100 mi. or No. of Positive portions.
06-)-220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD
Rev. ].978
.: :: Date Collected '///' ~/ ~]r ~ ;~ Source
/ :~;' .i a.m.
READ INSTRUCTIONS ~, ,,
Date Received , / · ! ''~ Time Received p.m, Lab. No.
BEFORE
COLLECTING SAM PLE
Form No. 18-310(3-78)
Presumptive :[0mi 10mi 10mi 10mi 10mi 1.0mi 0.1mi
24 Hours
48 Hours -
Confirmatory
24- Hours
48 Hours
EMB Broth 24 hours: Broth 48 hours:___ ,
~' ' 10mi Tubes Positive/Total 10mi Portion~
Coliform/100ml
Multiple Tube Report:
Membrane Filter: Direct Count
Verification: LTB
Final Membrane Filter Results
Reported By
BGB
Coliform/Z00ml
Date
Time- a.m.